Diagnostic approach to the adult with jaundice or asymptomatic hyperbilirubinemia
- Authors
- Namita Roy-Chowdhury, PhD
Namita Roy-Chowdhury, PhD
- Professor of Medicine and Genetics
- Albert Einstein College of Medicine
- Jayanta Roy-Chowdhury, MD, MRCP
Jayanta Roy-Chowdhury, MD, MRCP
- Professor of Medicine and Genetics
- Albert Einstein College of Medicine
- Section Editor
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — General Hepatology; Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
- Deputy Editor
- Shilpa Grover, MD, MPH, AGAF
Shilpa Grover, MD, MPH, AGAF
- Deputy Editor — Gastroenterology/Hepatology
- Assistant Professor of Medicine, Part-time
- Harvard Medical School
INTRODUCTION
Jaundice and asymptomatic hyperbilirubinemia are common clinical problems that can be caused by a variety of disorders, including bilirubin overproduction, impaired bilirubin conjugation, biliary obstruction, and hepatic inflammation. (See "Classification and causes of jaundice or asymptomatic hyperbilirubinemia".)
This topic will provide an overview of the diagnostic approach to adults with jaundice or asymptomatic hyperbilirubinemia. The causes of jaundice and asymptomatic hyperbilirubinemia, detailed discussions of the specific testing used, and the evaluation of patients with other liver test abnormalities are discussed elsewhere. (See "Classification and causes of jaundice or asymptomatic hyperbilirubinemia" and "Approach to the patient with abnormal liver biochemical and function tests".)
REFERENCE RANGES
Liver test reference ranges will vary from laboratory to laboratory. As an example, one hospital's normal reference ranges for adults are as follows [1]:
●Albumin: 3.3 to 5.0 g/dL (33 to 50 g/L)
●Alkaline phosphatase:
Subscribers log in here
To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:Literature review current through: Jun 2017. | This topic last updated: Jun 23, 2016.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.References- http://mghlabtest.partners.org/MGH_Reference_Intervals_August_2011.pdf (Accessed on March 29, 2013).
- Reisman Y, Gips CH, Lavelle SM, Wilson JH. Clinical presentation of (subclinical) jaundice--the Euricterus project in The Netherlands. United Dutch Hospitals and Euricterus Project Management Group. Hepatogastroenterology 1996; 43:1190.
- Saini S. Imaging of the hepatobiliary tract. N Engl J Med 1997; 336:1889.
- Teplick SK, Flick P, Brandon JC. Transhepatic cholangiography in patients with suspected biliary disease and nondilated intrahepatic bile ducts. Gastrointest Radiol 1991; 16:193.
- Sahai AV, Mauldin PD, Marsi V, et al. Bile duct stones and laparoscopic cholecystectomy: a decision analysis to assess the roles of intraoperative cholangiography, EUS, and ERCP. Gastrointest Endosc 1999; 49:334.
Top- INTRODUCTION
- REFERENCE RANGES
- CAUSES OF HYPERBILIRUBINEMIA
- DIAGNOSTIC EVALUATION
- History and physical examination
- Initial laboratory tests
- - Normal alkaline phosphatase and aminotransferases
- - Predominant alkaline phosphatase elevation
- - Predominant aminotransferase elevation
- - Elevated INR
- Subsequent evaluation
- - Unconjugated hyperbilirubinemia
- - Conjugated hyperbilirubinemia
- Suspected biliary obstruction or intrahepatic cholestasis
- Suspected hepatocellular injury
- Isolated conjugated hyperbilirubinemia
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- REFERENCES